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Conundrums for Atrial Fibrillation Management in Older Adults

  • Cardiovascular Disease in the Elderly (DE Forman, Section Editor)
  • Published:
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Abstract

Atrial fibrillation (AF) afflicts over 33 million people worldwide, the large majority of them older than 65, and increases embolic stroke risk fourfold to fivefold. This stroke risk can be reduced by two thirds or more with anticoagulation, although this benefit is balanced by an increased risk of bleeding. Guidelines recommend use of the CHA2DS2-VASc risk score to estimate annual stroke risk and inform shared decision making between patients and providers. Although the net clinical benefit of anticoagulation for stroke prophylaxis in AF is well established in patients with CHA2DS2-VASc scores ≥2, anticoagulation remains underutilized, especially in older patients. While older patients are at higher risk for bleeding on anticoagulation, they also derive the most benefit from anticoagulation due to their higher stroke risk. In this review, benefits of warfarin and targeted oral anticoagulants will be discussed, and relative utility of these therapies for stroke prophylaxis will be clarified.

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Conflict of Interest

Alexander C. Fanaroff declares that he has no conflict of interest. Tracy Y. Wang has received compensation from AstraZeneca, Premier, and Eli Lilly and has received institutional research funding through grants from Lilly USA, Daiichi Sankyo, Gilead Science, GlaxoSmithKline, Regeneron, Boston Scientific, and Bristol-Myers Squibb.

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  1. Division of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA

    Alexander C. Fanaroff

  2. Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, 27705, USA

    Tracy Y. Wang

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Correspondence to Alexander C. Fanaroff.

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This article is part of the Topical Collection on Cardiovascular Disease in the Elderly

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Fanaroff, A.C., Wang, T.Y. Conundrums for Atrial Fibrillation Management in Older Adults. Curr Geri Rep 4, 368–376 (2015). https://doi.org/10.1007/s13670-015-0143-8

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